Objective To investigate the application of No10-11 group lymphatic dissection with preservation of the spleen in radical surgery for pancreatic gastric body cancer. Methods A retrospective analysis was performed on 60 patients who underwent lymph node dissection of the splenic hilum using a hold-out approach, and the literature was investigated to analyze the necessity of preserving the spleen. Results The total number of No10 and 11 lymph node dissection in this group data was 152, and the number of positive lymph nodes was 21, with a positive rate of 13.8%. There were no serious complications related to lymphatic dissection in this group. Conclusion It is possible to safely and completely remove the splenic hilar lymph nodes while preserving the spleen. Currently, D2 surgery is widely recognized as the standard procedure for progressive gastric cancer. The splenic hilar lymph nodes (No10) and pars splenic artery lymph nodes (No11) belong to the lymph nodes at station 2 of upper middle gastric cancer (including gastric cancer in the M and U regions) and must be completely removed in standard D2-style radical gastric cancer surgery. Previously, in order to avoid residual metastatic positive lymph nodes, gastric cancer in the gastric body, fundus and cardia were routinely combined with splenectomy when radical surgery was performed. In recent years, with the advancement of surgical anatomical techniques and advanced equipment, splenectomy for splenic hilar lymph node dissection has been increasingly questioned and rejected. Splenic hilar lymphatic dissection with preservation of the spleen is also gaining more and more attention and application. From May 2009 to October 2010, 60 cases of radical surgery for upper middle gastric cancer with preservation of spleen were performed in our department, which are reported as follows: I. Clinical data 1. 2. Exclusion criteria (1) splenectomy during surgery; (2) extensive metastasis found intraoperatively and radical resection could not be performed; (3) early gastric cancer; (4) Borrman type IV gastric cancer. 3. General data According to the inclusion and exclusion criteria, a total of 60 cases, 34 males and 26 females, aged 35-78 years, with an average age of 54 years, were finally included in this study. All of them were confirmed by gastroscopy, pathology and CT as cardia cancer in 12 cases and fundic body cancer in 48 cases; all of them were progressive gastric cancer, and all of them underwent total gastrectomy and Roux-en-y anastomosis of esophagus and jejunum; among them, 5 cases were Borrman type I, 22 cases were type II and 33 cases were type III. The incision was made through a median epigastric incision, and the umbilicus was wrapped around the umbilicus to 2-3 c m below the umbilicus. After total gastrectomy outside the omental sac, the corresponding lymph nodes were cleared (No1-9, 12, 14); after the splenic colonic ligament and splenodiaphragmatic ligament were severed, the spleen was freed and the spleen was dragged out of the abdominal cavity together with the tail of the pancreatic body. The artery and its splenic portal vascular branches were skeletonized, and the No10 and No11 groups of lymph nodes were cleared from the superficial and deep upper and lower four interfaces with the pancreas and spleen as the axes. After the operation, the spleen was placed back into the splenic fossa, taking care not to distort the splenic hilar vessels and not to fix the spleen, and postoperative care was taken to lie flat for 48 hours. II. Results The total time for freeing the spleen and clearing the splenic hilar lymph nodes, the total operating time, the amount of bleeding during clearing the splenic hilar lymph nodes, and the total intraoperative bleeding are shown in Table 1; the number of postoperative hospital days ranged from 9 to 14 days. Two cases of incisional infection and one case of lymphatic leak occurred postoperatively; there was no intraoperative splenic laceration, no postoperative ischemic necrosis of the spleen, no pancreatic leak, no abdominal bleeding, and no serious complications such as subdiaphragmatic abscess. The postoperative pathological results showed that the total number of N10 and 11 lymph nodes cleared was 152, and the number of positive lymph nodes was 21, with a positive rate of 13.8%. The study of lymphatic flow direction found that the lymphatic fluid in the upper third of the lateral greater curvature of the stomach could drain along the short gastric artery to the splenic hilar lymph nodes or the lymph nodes around the trunk of the splenic artery, and the lymphatic fluid in the posterior wall of the stomach flowed along the posterior pancreatic artery or directly to the lymph nodes around the trunk of the splenic artery. Kikuchi et al. studied 104 patients with progressive gastric cancer and found that 24 cases had splenic hilar lymphatic metastases, accounting for about 23.1%. Gao Hongqiao et al. reported that No10 metastasis rate was 12.9% and No.11 metastasis rate was 9.1%. The pathology of 60 patients in our group suggested that the positive rate of lymph nodes in No10 and 11 groups was 13.8%, which is roughly similar to the literature. Therefore, it is necessary to clear No10 and 11 lymph nodes for gastric body and cardia cancer, otherwise there is a possibility of tumor residual. Previously, the spleen was often removed for complete removal of lymph nodes. As the immune function of the spleen has been elucidated, the spleen possesses 25% of the body’s lymphoid tissue, which not only removes foreign bodies, bacterial antigens and tumor cells from the blood, but also produces modulators and antigens that have an impact on maintaining the body’s anti-tumor immunity. In a comparative study of spleen preservation versus combined splenectomy, Roderich et al. suggested that radical surgery for gastric cancer combined with splenectomy or caudal resection of the pancreatic body did not improve patient survival, and even decreased survival in some patients after splenectomy. a multicenter prospective randomized trial conducted in the Netherlands reported by Hartgrink et al. concluded that combined splenectomy significantly increased the incidence of surgical complications and It is believed that better outcomes will be achieved if expanded lymph node dissection with preservation of the pancreas and spleen is performed. After studying the data of 692 gastric cancer patients, Han Fanghai et al. found that the mean survival time and median survival time of the combined splenectomy group for stage I and II gastric cancer were significantly shorter than those of the gastrectomy-only group, while the differences in mean survival time and median survival time between the combined splenectomy group and the gastrectomy-only group for stage III and IV gastric cancer were not statistically significant. Ji Jiafu concluded that splenic hilar lymph node dissection with spleen preservation is safe and feasible in the treatment of gastric cancer with sufficient experience. Therefore, the rationale for spleen preservation includes the following: (1) splenectomy images immune function; (2) improved surgical technique allows complete clearance of No10 and 11 lymph nodes; and (3) spleen preservation is considered an independent influence on prognosis. Our data showed that preserving the spleen did not increase the surgical risk and the occurrence of postoperative related complications, so we believe that for upper and middle stage progressive gastric cancer, it is safe and feasible to use drag-out extraperitoneal preservation of the spleen No10 to 11 group lymphatic dissection if the tumor does not directly invade the spleen or the tail of the pancreatic body.